title: The changing face of orthostatic and neurocardiogenic syncope with age.
abstract: OBJECTIVE
  Reports of the outcomes of syncope assessment across a broad spectrum of ages in a single population are scarce. It is our objective to chart the varying prevalence of orthostatic and neurocardiogenic syncope (NCS) as a patient ages.
  
  
  METHODS
  This was a retrospective study. All consecutive patients referred to a tertiary referral syncope unit over a decade were included. Patients were referred with recurrent falls or orthostatic intolerance. Tilt tests and carotid sinus massage (CSM) were performed in accordance with best practice guidelines.
  
  
  RESULTS
  A total of 3002 patients were included (1451 short tilt, 127 active stand, 1042 CSM and 382 prolonged tilt). Ages ranged from 11 to 91 years with a median (IQR) of 75 (62-81) years. There were 1914 females; 1088 males. Orthostatic hypotension (OH) was the most commonly observed abnormality (test positivity of 60.3%). Those with OH had a median (IQR) age of 78 (71-83) years. Symptomatic patients were significantly younger than asymptomatic (P = 0.03). NCS demonstrated a bimodal age distribution. Of 194 patients with carotid sinus hypersensitivity, the median age (IQR) was 77 (68-82) years. Those with vasovagal syncope (n = 80) had a median (IQR) age of 30 (19-44) years. There were 57 patients with isolated postural orthostatic tachycardia syndrome. Of the total patients, 75% were female. They had a median (IQR) age of 23 (17-29) years.
  
  
  CONCLUSIONS
  We have confirmed, in a single population, a changing pattern in the aetiology of syncope as a person ages. The burden of disease is greatest in the elderly.
authors.affiliation: Mid-Western Regional Hospital (Department of Medicine, Division of Ageing & Therapeutics) & Graduate Entry Medical School, University of Limerick, Limerick, Ireland. johnp.cooke@yahoo.com
authors.forename: J
authors.initials: J
authors.lastname: Cooke
authors.forename: S
authors.initials: S
authors.lastname: Carew
authors.forename: A
authors.initials: A
authors.lastname: Costelloe
authors.forename: T
authors.initials: T
authors.lastname: Sheehy
authors.forename: C
authors.initials: C
authors.lastname: Quinn
authors.forename: D
authors.initials: D
authors.lastname: Lyons
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D002648:Child; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D015995:Prevalence; D012189:Retrospective Studies; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D018667:Tilt-Table Test; D055815:Young Adult